Bradley Hospital Study Finds Difference in the Way Bipolar Disorder Affects the Brains of Children versus Adults

A new study from Bradley Hospital has found that bipolar
children have greater activation in the right amygdala – a brain region very
important for emotional reaction – than bipolar adults when viewing emotional
faces. The study, now published online in JAMA Psychiatry, suggests that bipolar
children might benefit from treatments that target emotional face
identification, such as computer based “brain games” or group and individual
therapy.

This study is the first ever
meta-analysis to directly compare brain changes in bipolar children to bipolar
adults, using data from 100 functional ​MRI (fMRI) brain imaging studies with a pool of thousands
of participants. Ezra Wegbreit, PhD, a postdoctoral research fellow at
Bradley Hospital, led the study along with senior author Daniel Dickstein, MD,
director of the PediMIND
Program at Bradley Hospital.

“Bipolar disorder is among the most debilitating psychiatric
illnesses affecting adults worldwide, with an estimated prevalence of one to
four percent of the adult population, but more than 40 percent of adults report
their bipolar disorder started in childhood rather than adulthood,” said
Wegbreit. “Despite this, very few studies have examined whether brain or
behavioral changes exist that are specific to children with bipolar disorder
versus adults with bipolar disorder.”

While fMRI studies have begun to investigate the neural
mechanisms underlying bipolar disorder, few have directly compared differences
in youths with bipolar disorder and bipolar adults. To address this gap, the
research team conducted the large scale meta-analyses, directly comparing fMRI
findings in bipolar youths versus bipolar adults, both relative to non-bipolar
participants.

Analysis of emotional face recognition fMRI studies showed
significantly greater amygdala activity among bipolar youths than bipolar
adults. The team also analyzed studies using emotional stimuli, which again
showed significantly greater levels of brain activation in bipolar children,
this time in the inferior frontal gyrus and precuneus areas of the brain. In
contrast, analyses of fMRI studies using non-emotional cognitive tasks showed a
significant lack of brain activation in the anterior cingulate cortex of
bipolar children.

“Our meta-analysis has located different regions of the
brain that are either hyper active or under active in children with bipolar
disorder,” said Wegbreit. “These point us to the targeted areas of the brain
that relate to emotional dysfunction and cognitive deficits for children with
bipolar disorder.”

“Despite our best current treatments, bipolar disorder
exacts a considerable toll on youths, including problems with friends, parents
and at school, and high rates of psychiatric hospitalization and suicide
attempts,” said Dickstein. “More research into targeted treatments is needed
now that we know children’s brains are impacted in specific, identifiable ways
by bipolar disorder.”

Dickstein added that Bradley Hospital’s PediMIND Program is
currently conducting several research projects on pediatric bipolar disorder,
including potential brain-based treatment. “Understanding more about the brains of children and adults with mental
illness is very important because, ultimately, all mental illnesses are
reflected in changes in brain activity,” said Dickstein. “Locating the
underlying brain change in bipolar youths could lead us to new, brain-based
ways to improve how we diagnose and treat this disorder.”

Ongoing studies by the PediMIND Program and other research
groups are working to determine if computer-based “brain games” or group or
individual therapy might improve these brain changes in a more targeted way,
and improve the lives of children and adults with bipolar
disorder.

This study was supported by the National Institute of Mental
Health (NIMH) under grant number T32MH019927.